Patient fluid line access valve antimicrobial cap/cleaner

ABSTRACT

Methods for cleaning and antiseptically maintaining patient fluid line access valves to minimize the risk of infection via catheters. The methods include cleaning patient fluid line access valves devices with a cap that may contain a dry pad impregnated with an antimicrobial agent. Covering the access portion of the access valve when not in use with the cap. The devices have a hood that contains a wet pad impregnated with a cleaning solution and, optionally, an antimicrobial agent. The methods include wet pad cleaning the access portion of the access valve prior to and optionally, after the access valve is utilized to access the patient fluid line.

RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.15/041,939, filed Feb. 11, 2016, which is a continuation of U.S.application Ser. No. 14/159,959, filed Jan. 21, 2014, titled PATIENTFLUID LINE ACCESS VALVE ANTIMICROBIAL CAP/CLEANER, granted on Mar. 15,2016 as U.S. Pat. No. 9,283,367, which is a continuation of U.S.application Ser. No. 11/281,711, filed Nov. 17, 2005, titled PATIENTFLUID LINE ACCESS VALVE ANTIMICROBIAL CAP/CLEANER, granted on Jun. 3,2014 as U.S. Pat. No. 8,740,864 which are incorporated herein in theirentirety.

BACKGROUND OF THE INVENTION

Catheter-related bloodstream infections are caused by bacteria/fungi inpatients with intravascular catheters. These infections are an importantcause of illness and excess medical costs, as approximately 80,000catheter-related bloodstream infections occur in U.S. intensive careunits each year. In addition to the monetary costs, these infections areassociated with anywhere from 2,400 to 20,000 deaths per year.

Guidelines from the Centers for Disease Control and Prevention describevarious ways to limit catheter-related bloodstream infections inhospital, outpatient and home care settings. The guidelines addressissues such as hand hygiene, catheter site care and admixturepreparation. Despite these guidelines, 15 catheter-related bloodstreaminfections continue to plague our healthcare system.

Impregnating catheters with various antimicrobial agents is one approachthat has been implemented to prevent these infections. These catheters,however, have given less than satisfactory results. In addition, somemicrobes have developed resistance to the various antimicrobial agentsin the system.

In another system that is commercially available in Europe, a catheterhub containing an antiseptic chamber is filled with three percentiodinated alcohol. Though it has shown to be effective, the catheter hubis expensive and does not fare as well in a formal cost-benefitanalysis. Therefore, there is a need for an effective and inexpensiveway to reduce the number of catheter-related infections.

BRIEF SUMMARY OF THE INVENTION

The present invention provides devices and methods for antisepticallymaintaining a patient fluid line access valve. The device includes ahousing for covering the access portion of the access valve. A padwithin the housing contacts the surface of the access portion of theaccess valve prior to (and optionally after) accessing the patient fluidline via the access valve to reduce the amount of microbes on thevalve's access portion.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an exploded view of a first representative embodiment of acap/cleaner device and a patient fluid line access valve.

FIG. 2 is a cross-sectional side view of the first representativeembodiment of the cap/cleaner device.

FIG. 3 is a cross-sectional side view of the first cap/cleaner devicecapping a patient fluid line access valve.

FIG. 4 is a cross-sectional side view of the first cap/cleaner devicecleaning a patient fluid line access valve.

FIG. 5 is a flow chart illustrating representative embodiments ofmethods of using the cap/cleaner device.

FIG. 6 is a perspective view of a second representative embodiment of acap/cleaner device.

FIG. 7 is a cross-sectional side view of the second cap/cleaner device.

FIG. 8 is a cross-sectional view of a first separable connector.

FIG. 9 is a side view of a second separable connector.

FIG. 10A is a cross-sectional view of cleaning device.

FIG. 10B is a cross-sectional view of a capping device.

DETAILED DESCRIPTION

FIG. 1 shows an exploded view of patient fluid line access valvecap/cleaner device 10 with patient fluid line access valve A and patientfluid line B. Cap/cleaner 10 includes housing 12 with cap end 14,cleaning end 16 and thread 18; and lid 20. Access valve A includeshousing A2 with thread A4 and septum A6 with slit A8. The exposedsurface of septum A6 Along with at least a portion of the exposedsurface of housing A2 that surrounds septum A6, form access portion A10of access valve A. Line B may be any of a number of types that include,for example, intravascular (IV) lines and catheters, saline wells,arterial lines and hemodialysis lines.

As will be described in more detail below, cap end 14 of cap/cleaner 10attaches to access portion A10 of access valve A. Housing 12 is madefrom any of a number of types of plastic materials such aspolycarbonate, polypropylene, polyethylene, glycol-modified polyethyleneterephthalate, acrylonitrile butadiene styrene or any other moldableplastic material used in medical devices.

Cap end 14 of housing 12 is open and contains thread 18 Along the insideof the opening. Cleaning end 16 is covered by lid 20. Lid 20 istypically made of foil or similar type material and completely seals theopening (not shown) of cleaning end 16. Any type of material or seal maybe used as long as a moisture barrier is provided.

FIG. 2 shows cap/cleaner 10 in more detail. In addition to thestructures shown in FIG. 1, cap/cleaner 10 also includes internal wall12 a, hood 16 a and chamber 16 b of cleaning end 16, cap 14 a and cavity14 b of cap end 14, wet pad 22 within chamber 16 b and dry pad 24 withincavity 14 b. Internal wall 12 a separates cap end 14 and cleaning end16.

Cap/cleaner 10 is typically distributed and stored in a sterile, sealedpackage either Alone or paired with a patient fluid line access valve.One such type of valve is the BD Q-Syte™ valve from Becton, Dickinsonand Company (illustrated in FIG. 1). However, cap/cleaner 10 is usefulwith any type of needleless or needle required access valve. Onceremoved from the package, cap/cleaner 10 is ready for use.

FIG. 3 illustrates cap/cleaner 10 covering access portion A10 of accessvalve A. Septum A6 provides an accessible seal for either a needle or amale luer taper. In the case of a needleless access device, such as thatshown in FIG. 3, slit A8 extends through septum A6 to provide a port forinsertion of the male luer taper.

As shown, cap end 14 includes cap 14 a with cavity 14 b, which containsdry pad 24. Dry pad 24 is impregnated with an antimicrobial agent to aidin maintaining antiseptic conditions of access portion A10 of valve A.Suitable material for dry pad 24 includes non-woven material or a foamsponge pad made of polyurethane, polyester, cotton or any bioengineeredplastic material such as silicone. Any of a number of antimicrobialagents may be used to impregnate dry pad 24. Some examples includechlorhexidine gluconate, chlorhexidine diacetate, chloroxylenol,povidone iodine, Triclosan, benzethonium chloride, benzalkoniumchloride, octenidine, antibiotic, etc. Alternatively, cap end 14 doesnot contain dry pad 24 and aids in maintaining antiseptic conditions bysimply covering access portion A10.

In use, cap end 14 of cap/cleaner 10 is placed over access portion A10such that access portion A10 is within cavity 14 b of cap end 14.Cap/cleaner 10 may be attached either prior to or after placement ofvalve A for the patient. As shown in FIG. 3, valve A includes thread A4.By rotating cap/cleaner 10 or valve A relative to one another, threadsA4 and 18 (of cap/cleaner 10) interlock to provide a secured attachment.It is not necessary, however, for valve A to include thread A4. Cap end14 will also attach and hold a luer slip, which does not have a thread.In other embodiments, cap/cleaner 10 may be manufactured without athread.

The amount of material used for dry pad 24 can vary. Typically, there isenough material for dry pad 24 to contact at least septum A6 of valve A.Enough space should be left in cavity 14 b of cap end 14 for accessportion A10 of valve A to be encompassed by cap end 14, thus,maintaining antiseptic conditions of the surface. By maintainingantiseptic conditions of the surface, the risk of microbes penetratinginto valve A is minimized.

To further minimize the opportunity for penetration by microbes, accessportion A10 is cleaned prior to accessing valve A with a needle or maleluer taper. FIG. 4 illustrates cap/cleaner 10 cleaning access portionA10 of valve A.

As shown in FIG. 4, cleaning end 16 includes hood 16 a and chamber 16 b,which contains wet pad 22. Wet pad 22 is impregnated with a cleaningagent and optionally, an antimicrobial agent. Wet pad 22 may be madefrom materials similar to those described for dry pad 24.

The cleaning solution is typically an alcohol- or water-based solution.A suitable alcohol-based solution contains about 50% to about 100% (noadditional water) of an alcohol solution. The balance of solutions thatare less than 100% alcohol contain water and other optional materialssuch as fragrance, dye, surfactant, emollient, etc.

Suitable water-based solutions contain about 1% to about 10% alcoholsolvent as a wetting agent and about 90% to about 99% water. Again,optional materials may also be added such fragrance, dye, surfactant,emollient, etc.

In an alternative embodiment, the cleaning solution also includes anantimicrobial agent. Any of a number of antimicrobial agents may be usedin wet pad 22. Some examples include chlorhexidine gluconate,chlorhexidine diacetate, chloroxylenol, povidone iodine, Triclosan,benzethonium chloride, benzalkonium chloride, octenidine, antibiotic,etc. Wet pad 22 and dry pad 24 may be impregnated with the same ordifferent antimicrobial agents.

As shown in the Figures, cleaning end 16 is larger than cap end 14. Thehood of cleaning end 16 loosely encompasses at least access portion A10of valve A, and chamber 16 b is sized to allow some movement when accessportion A10 is inserted. The amount of material used for wet pad 22 willvary, but the amount should hold enough cleaning solution and allowenough movement for thorough cleaning. Wet pad 22 should be containedentirely within hood 16 a such that it is recessed inside chamber 16 bof cleaning end 16.

In preparation for accessing valve A, cap end 14 is removed from valve Aeither by rotating cap/cleaner 10 to release threads 18 and A4 or bysimply pulling if valve A does not have a thread. Lid 20 is removed fromcleaning end 16. Cleaning end 16 is then placed over at least accessportion A10, such that wet pad 22 contacts septum A6. Though FIG. 4 onlyshows contact with septum A6, additional pressure may be applied suchthat wet pad 22 extends beyond the edges of septum A6 to contactportions of the exposed surface of housing A2.

Next, for thorough cleaning, wet pad 22 should scrub access portion A10of valve A. Scrubbing may be accomplished by, for example, rotationalmovement or back and forth movement. Scrubbing should be carried out fora time long enough to allow the cleaning solution to at least disinfectaccess portion A10 of valve A.

Once cleaned, valve A is ready to use. A needle or male luer taper isinserted to either infuse or withdraw fluid from the patient fluid line.

FIG. 5 is a flowchart illustrating representative embodiments of methodsfor using cap/cleaner 10. Capping step 34, cleaning step 36 andaccessing step 38 were described above and are the same in eachembodiment. However, upon withdrawal after accessing the patient fluidline, access portion A10 of valve A may either be immediately capped orcleaned again prior to capping. If immediately capped, a new, secondcap/cleaner 10A is obtained and removed from its package. This isrepresented by step 40. Cap end 14 of cap/cleaner 10A is placed overaccess portion A10 as described above. Cleaning end 16 of cap/cleaner10A is sealed and ready for the next time valve A is utilized.

Alternatively, access portion A10 may be cleaned again prior to capping.This can be performed in one of the following ways. First, in step 42,cleaning end 16 of cap/cleaner 10 is reused to clean access portion A10,which is then capped, at step 44, with cap end 14 of a new, secondcap/cleaner 10A. Second, in step 46, cleaning end 16 of a new, secondcap/cleaner 10A is used to clean access portion A10. Then, valve A maybecapped either with cap end 14 of cap/cleaner 10A (step 48) or of a new,third cap/cleaner 10B (step 50). Third, in step 52, access portion A10may be cleaned with an alternative disposable cleaning device that iswell known in the art. Examples of such cleaning devices include alcoholwipes, iodine swabs, etc. Once cleaned, cap end 14 of a new, secondcap/cleaner 10A may be attached to valve 26 (step 50).

Additional embodiments of the present invention include separable andindividual, uncoupled devices. FIG. 6 shows separable cap/cleaner 56.Separable cap/cleaner 56 includes cap end 58, cleaning end 60 and gap62. Gap 62 is the separation between cap end 58 and cleaning end 60.

FIG. 7 shows separable cap/cleaner 56 in more detail and furtherincludes dry pad 64 within cap end 58, wet pad 66 within cleaning end 60and breakable connector 68. In use, separable cap/cleaner 56 operates asdescribed above for 10 cap/cleaner 10 except that cleaning end 60 may beremoved after cleaning access portion A10 of valve A. Detaching cleaningend 60 reduces bulkiness from separable cap/cleaner 56 by onlymaintaining cap end 58 over access portion A10.

FIG. 8 shows a representative embodiment of breakable connector 68.Connector 68 is typically made of the same material from which housing12 is fabricated. Torsional shearing caused by twisting cap end 58and/or cleaning end 60 relative to each other may be used to breakconnector. Alternatively, a three-point bending force, which consists ofa fulcrum (connector 68) that directs a force vector contralateral tothe direction of the terminal (cap end 58 and cleaning end 60) forcevectors, may be applied for breaking connector 68. Once removed,cleaning end 60 may be discarded.

FIG. 9 is an alternate embodiment showing notched breakable connector70. Notch 72 within connector 70 is an area of reduced cross-sectionalarea, which acts as a score to facilitate breaking of connector 70.

Other separation mechanisms may also be used to remove cleaning end 60from cap end 58. For instance, a luer lock type mechanism can beutilized to separate ends 58 and 60 from each other.

FIG. 10A shows a representative embodiment of cleaning device 74 withlid 74 a and wet pad 76. Here, cleaning device 74 is a stand-alonedevice that is used as described above for cleaning end 16.

FIG. 10B shows a representative embodiment of cap device 78 with lid 78a and pad 80. Cap device 78 is a stand-alone device where pad 80 mayeither be a wet pad or a dry pad. Where pad 80 is a dry pad, cap device78 is used as described above for cap end 14.

Where pad 80 is a wet pad, cap device 78 may be used to clean accessportion A10 of valve A in addition to its capping function. The twistingmotion involved in removing and placing cap device 78 with respect toaccess portion A10 provides friction for cleaning. Additional cleaningcan be accomplished by twisting cap device 78 in one direction and thenin the reverse direction for a desired amount of time.

Cap device 78 further comprises an inner circumference 82 that defines acavity in which pad 80 is housed. In some instances, cap device 78comprises a thread or threading 18 having a length that is less thaninner circumference 82.

With either cleaning device 74 or cap device 78, additional grippingsurface may be added by extending the length of the housing. Theincreased gripping surface would provide easier handling of devices 74and 78.

Cap/cleaner 10 cleans and maintains access valves in antiseptic oraseptic condition. This substantially decreases the risk of patientinfections caused by the ingress of microbes into the access valves,particularly for needleless access valves.

Although the present invention has been described with reference topreferred embodiments, workers skilled in the art will recognize thatchanges may be made in form and detail without departing from the spiritand scope of the invention.

1. A method for maintaining a patient fluid line access valve having anaccess portion with a distalmost end face that includes a septum andexternal threads on the access portion proximate the distalmost endface, the method comprising: receiving the access portion of the patientfluid line access valve in an inner cavity of a housing having anopening to the inner cavity, a threading protruding inwardly into theinner cavity from an inner wall of the housing near the opening, and amaterial impregnated with a liquid antimicrobial agent and disposed inthe inner cavity prior to receiving the access portion of the patientfluid line access valve; engaging the external threads of the accessportion of the patient fluid line access valve by the threadingprotruding inwardly into the inner cavity as the housing is placed overthe access portion of the patient fluid line access valve to contact thematerial with the distalmost end face of the access portion of thepatient fluid line access valve; and disinfecting the distalmost endface and at least a portion of the external threads of the accessportion of the patient fluid line access valve with the liquidantimicrobial agent from the material, wherein the threading receivesthe external threads of the access portion of the access valve therebycausing the distalmost end face to advance into the inner cavity suchthat the septum contacts the material.
 2. The method of claim 1, whereina threaded interaction between the threading and the external threads isconfigured to provide adjustable positioning of the septum within theinner cavity.
 3. The method of claim 2, wherein adjustable positioningof the septum within the inner cavity is configured to allow the septumto contact the material, and is further configured to allow the septumto contact and compress the material between the septum and the innercavity.
 4. The method of claim 1, wherein the housing comprises apolyethylene or polypropylene material.
 5. The method of claim 1,wherein the antimicrobial agent comprises at least one of chlorhexidinegluconate and chlorhexidine diacetate.
 6. A method for maintaining apatient fluid line access valve having an access portion with adistalmost end face that includes a septum and external threads on theaccess portion proximate the distalmost end face, the method comprising:inserting the access portion of the patient fluid line access valve intothe cavity of a housing having an open end, a closed end, a cavity, athread on an inner wall of the cavity proximate the open end forengaging the external threads on the access portion of the patient fluidline access valve, and a material impregnated with a liquidantimicrobial agent prior to attachment of the housing to the accessportion of the patient fluid line access valve; advancing the accessportion of the patient fluid line access valve into the cavity; andcontacting the distalmost end face of the access portion of the patientfluid line access valve by the material impregnated with the liquidantimicrobial when the housing covers the access portion to reduce theamount of microbes on the access portion, wherein in response toinsertion of the access portion of the patient fluid line access valveinto the cavity, the thread is configured to engage the external threadson the access portion as the access portion is advanced into the innercavity so that the distalmost end face of the access portion contactsthe material to provide the liquid antimicrobial agent to the septum andat least a portion of the external threads.
 7. The method of claim 6,wherein the cavity comprises an inner circumference and the threadcomprises a length that is less than the inner circumference.
 8. Themethod of claim 6, wherein the antimicrobial agent comprises at leastone of chlorhexidine gluconate and chlorhexidine diacetate.
 9. A methodfor maintaining a threaded patient fluid line access valve having anaccess portion with a distalmost end face that includes a septum andexternal threads on the access portion proximate the distalmost endface, the device comprising: covering the access portion of the patientfluid line access valve by a housing having an inner cavity, a materialimpregnated with the liquid antimicrobial agent, and a thread within theinner cavity of the housing and positioned between the material and anopening to the inner cavity engaging the external threads of thethreaded patient fluid line access valve by the thread within the innercavity of the housing to cause the material to contact the distalmostend face of the patient fluid line access valve; and in response to thedistalmost end face of the access valve being inserted into the housingand the distalmost end face contacting the material, providing theliquid antimicrobial agent to the septum and at least a portion of theexternal threads.
 10. The method claim 9, wherein the inner cavitycomprises an inner circumference and the thread comprises a length thatis less than the inner circumference.
 11. The method of claim 9, whereinthe housing comprises a polyethylene or polypropylene material.
 12. Themethod of claim 9, wherein the liquid antimicrobial agent comprises atleast one of chlorhexidine gluconate and chlorhexidine diacetate. 13.The method of claim 1, wherein the material comprises a dry pad.
 14. Themethod of claim 13, wherein the dry pad comprises a sponge.
 15. Themethod of claim 1, wherein the liquid antimicrobial agent compriseschlorhexidine.
 16. The method of claim 1, wherein the liquidantimicrobial agent comprises one or more of the following:chloroxylenol, povidone iodine, Triclosan, and benzethonium chloride.17. The method of claim 1, wherein the liquid antimicrobial agentcomprises one or more of the following: benzalkonium chloride andoctenidine.
 18. The method of claim 1, wherein the liquid antimicrobialagent comprises an antibiotic.